Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan.
J Thorac Cardiovasc Surg. 2012 Jan;143(1):72-7, 77.e1-3. doi: 10.1016/j.jtcvs.2011.09.013. Epub 2011 Oct 20.
This study observed midterm results of vascular ring connectors in surgery for aortic dissection.
Vascular ring connectors were used as stents in vascular grafts to achieve quick, sutureless anastomoses. Tapes were used to secure ringed vascular grafts from outside the aorta.
From November 2007 to February 2011, 113 consecutive patients with aortic dissection, except 3 in preoperative profound shock, underwent open surgery. All underwent aortic reconstruction with vascular grafts and vascular ring connectors: ascending aorta in 29, descending thoracic aorta in 20, distal hemiarch plus descending thoracic aorta in 22, total arch in 14, ascending aorta plus total arch in 12, total arch plus descending thoracic aorta in 7, ascending aorta plus arch plus descending thoracic aorta in 8, and thoracoabdominal aorta in 1. Concomitant operations were 19 Bentall procedures, 14 coronary bypasses, 2 mitral valve replacements, 1 aortic valve replacement, and 1 heart transplant. We used sternotomy to repair 77% of type B dissections, 83% with elephant trunks. Time to extubation was 9.0 ± 6.2 hours. Average blood loss was 345 ± 195 mL. Half the patients needed no blood transfusion. In-hospital mortality was 5.3%; late mortality was 2.7%.
Use of vascular ring connectors in surgical repair for aortic dissection might reduce risks and improve early and midterm results. With addition of elephant trunk, most type B dissections could be repaired through sternotomy. With the improved surgical results, we can suggest open repair for most uncomplicated type B dissections; however, more long-term follow-up is needed.
本研究观察主动脉夹层手术中血管环连接器的中期结果。
血管环连接器用作血管移植物中的支架，以实现快速、无缝线吻合。使用带子将环状血管移植物固定在主动脉外。
2007 年 11 月至 2011 年 2 月，连续 113 例主动脉夹层患者（术前深度休克 3 例除外）接受了开放手术。所有患者均接受了血管移植物和血管环连接器的主动脉重建：升主动脉 29 例，降胸主动脉 20 例，远端半弓加降胸主动脉 22 例，全弓 14 例，升主动脉加全弓 12 例，全弓加降胸主动脉 7 例，升主动脉加弓加降胸主动脉 8 例，胸主动脉加腹主动脉 1 例。同时进行了 19 例 Bentall 手术、14 例冠状动脉旁路移植术、2 例二尖瓣置换术、1 例主动脉瓣置换术和 1 例心脏移植术。我们使用胸骨切开术修复了 77%的 B 型夹层，83%的患者使用象鼻手术。拔管时间为 9.0±6.2 小时。平均失血量为 345±195ml。半数患者无需输血。院内死亡率为 5.3%；晚期死亡率为 2.7%。
在主动脉夹层手术修复中使用血管环连接器可能会降低风险并改善早期和中期结果。通过增加象鼻手术，大多数 B 型夹层可以通过胸骨切开术进行修复。随着手术结果的改善，我们可以建议对大多数非复杂性 B 型夹层进行开放修复；然而，还需要更多的长期随访。
